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      Diverse Spectrum of Presentation of Coronary Slow Flow Phenomenon: A Concise Review of the Literature

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          Abstract

          The coronary slow flow phenomenon (CSFP) is a disease entity characterized by slow progression of angiographic contrast in the coronary arteries in the absence of stenosis in the epicardial vessels. CSFP has a diverse presentation from mild chest discomfort to ST-segment elevation myocardial infarction. It can also have severe morbidity and mortality implications and can significantly hamper the quality of life of those affected. In this paper we present two patients with CSFP highlighting the diverse spectrum of presentation. A concise review of the literature is also provided emphasizing the epidemiology, pathogenesis, diagnostic parameters, treatment modalities, and clinical significance of this phenomenon.

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          TIMI frame count: a quantitative method of assessing coronary artery flow.

          C Gibson, C Cannon, W Daley … (1996)
          Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is valuable and widely used qualitative measure in angiographic trials, it is limited by its subjective and categorical nature. In normal patients and patients with acute myocardial infarction (MI) (TIMI 4), the number of cineframes needed for dye to reach standardized distal landmarks was counted to objectively assess an index of coronary blood flow as a continuous variable. The TIMI frame-counting method was reproducible (mean absolute difference between two injections, 4.7 +/- 3.9 frames, n=85). In 78 consecutive normal arteries, the left anterior descending coronary artery (LAD) TIMI frame count (36.2 +/- 2.6 frames) was 1.7 times longer than the mean of the right coronary artery (20.4 +/- 3.0) and circumflex counts (22.2 +/- 4.1, P < .001 for either versus LAD). Therefore, the longer LAD frame counts were corrected by dividing by 1.7 to derive the corrected TIMI frame count (CTFC). The mean CTFC in culprit arteries 90 minutes after thrombolytic administration followed a continuous unimodal distribution (there were not subpopulations of slow and fast flow) with a mean value of 39.2 +/- 20.0 frames, which improved to 31.7 +/- 12.9 frames by 18 to 36 hours (P < .001). No correlation existed between improvements in CTFCs and changes in minimum lumen diameter (r=-.05, P=.59). The mean 90-minute CTFC among nonculprit arteries (25.5 +/- 9.8) was significantly higher (flow was slower) compared with arteries with normal flow in the absence of acute MI (21.0 +/- 3.1, P < .001) but improved to that of normal arteries by 1 day after thrombolysis (21.7 +/- 7.1, P=NS). The CTFC is a simple, reproducible, objective and quantitative index of coronary flow that allows standardization of TIMI flow grades and facilitates comparisons of angiographic end points between trials. Disordered resistance vessel function may account in part for reductions in flow in the early hours after thrombolysis.
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            Angina pectoris and slow flow velocity of dye in coronary arteries--a new angiographic finding.

            Mitali A. Tambe, Robert H Zimmerman, E Mascarenhas … (1972)
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              Slow coronary flow: clinical and histopathological features in patients with otherwise normal epicardial coronary arteries.

              P Motta, M Ciavolella, G Scibilia … (1996)
              Slow flow of dye in epicardial coronary arteries is not an infrequent finding in patients during routine coronary angiography. Whether this pattern of flow can be reversed by nitroglycerin or dipyridamole and whether this angiographic finding is associated with histopathological abnormalities is unknown. We hypothesized that this abnormality could be associated with small vessel disease of the heart, since the epicardial arteries are usually widely patent. Thus, out of the patients undergoing heart catheterization at our institution during the past 5 years, 10 (7%) presented with chest pain, normal epicardial coronary arteries, and abnormal coronary progression of dye. Rest electrocardiogram (ECG), exercise test, echocardiographic examination, and left ventricular angiogram were normal. Coronary angiography showed slow flow of dye on a total of 20 main coronary vessels, that was not reversed by intracoronary nitroglycerin administration. Six of them underwent dipyridamole intravenous infusion that normalized dye run-off in all affected vessels, for a total of 9 main coronary vessels. Histopathological examination (light and electron microscope) of left ventricular endomyocardial biopsies showed thickening of vessel walls with luminal size reduction, mitochondrial abnormalities, and glycogen content reduction. Normal and pathological zones often coexisted in the same specimen. Thus. In some patients with slow coronary flow and patent coronary arteries, functional obstruction of microvessels seems to be implicated, as it is relieved by dipyridamole infusion. Patchy histopathological abnormalities suggestive of small vessel disease are also detectable and could contribute to increase flow resistance.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cardiol Res Pract
                Journal ID (iso-abbrev): Cardiol Res Pract
                Journal ID (publisher-id): CRP
                Title: Cardiology Research and Practice
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2090-8016
                ISSN (Electronic): 2090-0597
                Publication date (Print): 2012
                Publication date (Electronic): 8 May 2012
                Volume: 2012
                Electronic Location Identifier: 383181
                Affiliations
                1Section of Cardiology, Department of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126-0901, USA
                2Cardiovascular Section, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
                Author notes

                Academic Editor: Michael S. Wolin

                Article
                DOI: 10.1155/2012/383181
                PMC ID: 3356868
                PubMed ID: 22645695
                SO-VID: 5e3eb7ca-8475-4d3a-9690-6f77f1141f2b
                Copyright © Copyright © 2012 Muhammad A. Chaudhry et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 October 2011
                Date revision received : 19 February 2012
                Date accepted : 20 February 2012
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine

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